Tips for Leveraging Motivational Interviewing in LAI Discussions in Schizophrenia

When counseling patients with schizophrenia about long-acting injectable (LAI) antipsychotics, clinicians should first acknowledge injection reluctance is often rooted in prior negative experiences and use motivational interviewing to align treatment decisions with patients' goals, according to Gerald A. Maguire, MD. Maguire discussed the issues with Psychiatric Times following his Continuing Education Spotlight Symposium, Integrating Motivational Interviewing Techniques to Overcome Barriers to the Use of Long-Acting Injectable Agents in Patients with Schizophrenia, at the 2026 Southern California Psychiatry Conference, emphasizing that LAI conversations should focus on collaboration rather than persuasion.

Recognizing the Origins of LAI Hesitancy

Many patients associate injections with traumatic experiences, particularly emergency intramuscular medications administered during psychiatric crises, Maguire told Psychiatric Times.

"There's an aversion to shots," he said. During the conference session, Jackie, a patient of Maguire’s for more than 30 years, described her traumatic experiences, recalling restraints and terrible adverse effects of haloperidol injections years earlier. The fact that the experience remained so vivid for her 40 years is very telling, he added.

Those memories can shape how patients perceive LAIs, even though maintenance antipsychotic injections differ substantially from emergency medications, Maguire said. Beyond psychiatric experiences, Maguire noted that many individuals develop a general dislike of injections beginning in childhood, reinforcing the importance of addressing fears and anxieties to allow for a focus on the benefits of the medications.

Reframing Adherence as a Human Challenge

Maguire said he likes to frame the issue of medication adherence through a more empathetic lens. He frequently asks audiences whether they have ever failed to complete a prescribed course of antibiotics—a question that typically elicits widespread acknowledgment.

Adherence is a human issue, he told Psychiatric Times. "They [patients] are human. We're human."

By normalizing adherence challenges and using motivational interviewing to connect treatment options with patients' own priorities, clinicians may be better positioned to introduce LAIs as part of a shared decision-making process rather than a directive recommendation.

Motivational Interviewing Shifts the Conversation

Rather than attempting to convince patients to accept an LAI, Maguire told Psychiatric Times he encourages psychiatric clinicians to begin a conversation by exploring what patients hope to achieve, such as living independently, leaving the hospital, or becoming financially self-sufficient. Once those goals are identified, clinicians can discuss how consistent treatment may help support them.

"We never want to be coercive," Maguire said. "Ask what the patient's goals are." He suggested reviewing barriers that may have prevented patients from reaching those goals and presenting LAIs as one potential tool. Even so, Maguire is emphasized that patients should be able to make the final decision.

"I always say I'm the coach, but you're the player," he told Psychiatric Times. "I can help guide this... but it's your life... it's your decision."